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Contact Information

MARIO CARRILLO, DO
1676 SUNSET AVE
4TH FLOOR
UTICA, NY13502
 Phone: 315-624-4690
 Fax: 315-624-4840
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Vascular Surgery

2086S0129X 76 Physician/Peripheral Vascular Disease
Indicates primary specialty

NPI Profile & details for MARIO CARRILLO · (Male)

NPI Number 1053491936
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 10/16/2006
Last updated 03/23/2016 - About 10 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 213540
  • NY Medicaid 01976636
Hospital affiliation(s)
  • FAXTON-ST LUKE'S HEALTHCARE - (Acute Care)
    1656 CHAMPLIN AVENUE
    UTICA, NY 13503
  • ST ELIZABETH MEDICAL CENTER - (Acute Care)
    2209 GENESEE STREET
    UTICA, NY 13501
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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